Lisa Schulmeister

After a nurse wrote about her dissatisfaction with her work environment and her “incompetent” supervisor on her Facebook page, she was dismissed from employment. Although the reason for her dismissal was “overall poor job performance,” her comments about her supervisor were brought up during her termination.

Social networks, blogs, and other types of online communication can be used in health care in many different ways—both positive and negative. Most of the advice about using social media is to use common sense and for health care providers, to be professional. The American Medical Association (AMA) released its policy on professionalism in the use of social media in November 2010 (the American Nurses Association is in the process of developing a similar policy). Key points in the AMA policy include maintenance of patient privacy and confidentiality, use of privacy settings, and establishing professional boundaries to separate personal content from professional content. In addition, physicians have the responsibility to bring inappropriate and unprofessional content posted by their colleagues to the attention of those colleagues, and if professional norms are violated, the physician should report the matter to the appropriate authorities. The AMA notes that physicians must recognize that online content and actions can negatively affect their reputations among patients and colleagues and can undermine public trust. The full text of the AMA’s policy can be found at 

http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml

All health care providers need to examine how they use social media, both in their professional as well as personal lives, and be aware that sometimes the line between professional and personal may be clear to them but not to others. As with conflict of interest, it is the perception of misuse of social media that is the core of the issue.

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Sometimes the line between personal and professional gets blurred.

Use of Social Media by Health Care Professionals

Updated guidelines for the prevention of bloodstream infections in patients with IV catheters were released by the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). These catheter-related bloodstream infections (CRBSIs) are known to be costly to the healthcare system, and sometimes are deadly for patients.

The updated "Guidelines for the Prevention of Intravascular Catheter-Related Infections" are available online at 

http://www.cdc.gov/ncpdcid/pdf/Draft_BSI_guideline_v15_2FR.pdf

 and will be published in a special supplement to the 

. The updated guidelines were developed by a working group led by the Society of Critical Care Medicine, in collaboration with the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Surgical Infection Society, American College of Chest Physicians, American Thoracic Society, American Society of Critical Care Anesthesiologists, Association for Professionals in Infection Control and Epidemiology, Infusion Nurses Society, Oncology Nursing Society, American Society for Parenteral and Enteral Nutrition, Society of Interventional Radiology, American Academy of Pediatrics, Pediatric Infectious Diseases Society, and the CDC Healthcare Infection Control Practices Advisory Committee.

The primary change in the guidelines is the addition of recent research findings that support evidence-based practice. Major areas of clinical interest include 1) educating and training healthcare personnel who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters and chlorhexidine impregnated sponge dressings if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also emphasize performance improvement by implementing bundled strategies, documenting and reporting rates of compliance rates with all components of the bundle as benchmarks for quality assurance and performance improvement. As in previous guidelines issued by CDC and HICPAC, each recommendation is categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact.

CDC guidelines issued in 2002 are now updated.

CDC Updates Guidelines for the Prevention of Catheter-Related Infection

There are a number of organizations that offer information, resources, and support services for people living with kidney cancer. In addition to the general cancer organizations, there are a few organizations that focus specifically on kidney cancer. Following is a list of organizations that may be of assistance to people living with kidney cancer (information is current as of March 14, 2011):

Increases awareness of kidney cancer and raises money to support research on more effective treatment of kidney cancer. The organization was initially established by people with kidney cancer in 2003.

Supports cancer research, education and advocacy. Provides supportive services for people with any type of cancer, such as transportation and medication assistance.  

Provides professional support services at no cost to people affected by any kind of cancer, including kidney cancer. Services are provided by trained oncology social workers and include counseling, education, financial assistance and practical help.

The Wellness Community and Gilda's Club joined forces in 2009 to become the Cancer Support Community (CSC). CSC provides support groups, counseling, education and healthy lifestyle programs for people with any type of cancer.

Funds, promotes and collaborates on kidney cancer research projects, educates healthcare providers and patients about kidney cancer, and advocates at the federal and state level on behalf of patient interests.

1-800-4-CANCER (1-800-422-6237), website: 

Utilizes information specialists to answer questions about any type of cancer and provides educational and resource materials. The NCI website provides comprehensive information on cancer prevention, diagnosis, treatment, statistics, research, clinical trials and news. Live help can be obtained via NCI’s instant messaging service, at 

National Coalition for Cancer Survivorship

Advocates for quality cancer care for all Americans and the empowerment of cancer survivors through federal policy initiatives.

Help kidney cancer patients by being aware of available resources and support services.

Resources for People Living with Kidney Cancer

In keeping with “March is Kidney Month,” test your knowledge of kidney cancer. Are the following statements myths or facts about kidney cancer?

Renal cell carcinoma is the only type of kidney cancer that can occur.

 The most common type of kidney cancer is renal cell carcinoma; however, less common types of kidney cancer are transitional cell carcinoma that affects the ureters but begins in the kidneys, and Wilms’ tumor of the kidney that can occur in children.

People with Von Hippel-Lindau syndrome are at higher risk for developing kidney cancer.

 Von Hippel-Lindau (VHL) syndrome, a rare familial disease caused by an abnormal VHL gene, increases a person’s risk of developing kidney cancer. The gene can also cause cysts or tumors to develop in the eyes, brain, and other body parts. Family members of patients with VHL who have kidney cancer can be tested to determine if they have the abnormal VHL gene, and if they do, can work with their healthcare providers to detect kidney cancer and VHL-related cysts/tumors before symptoms develop.

Blood in the urine is a sure sign of kidney cancer.

 While blood-colored, rusty, or deep red urine is a symptom of kidney cancer, red-appearing urine may also be a sign of non-cancerous disorders, such as a urinary tract infection. Red-tinged urine should never be ignored; it should be promptly evaluated by a healthcare provider. Other signs and symptoms of kidney cancer include persistent flank pain, lumps or masses in abdominal tissue, fatigue, fever, and weight loss.

How informed are you about this relatively uncommon cancer?

Lisa Schulmeister

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